Evaluation of methotrexate in the treatment of severe asthma

Abstract

Methotrexate (MTX) was proposed in 2014 by international ERS/ATS guidelines in patients with severe steroid-dependent asthma who require daily oral corticosteroids (OCS) and limited to specialised centres. Our objective was to reevaluate the efficacy and tolerance of methotrexate in the treatment of severe steroid-dependent asthma. A 5-year retrospective study was conducted and included patients followed by pneumologists with uncontrolled severe steroid-dependent asthma and who received at least one dose of methotrexate during their follow-up. 9 patients, 6 female and 2 male, mean age 49.3 years, were treated by methotrexate for severe allergic (6 patients) or non-allergic (3 patients) asthma. Before that treatment, 7 patients were treated by omalizumab and all patients were treated with OCS mean dose 38 mg of prednisolone. The duration of treatment by MTX averaged 27.4 months with a median of 11.5 months. The average dose of MTX was 13.8±2.3 mg with a median of 15 mg. A 55.6% decrease of the doses of OCS was observed in 7 patients. A reduction in the number of exacerbations at one per year and a clinical improvement was observed in 6 patients, 3 atopic and 3 non-atopic. In 3 patients, mean FEV 1 showed an improvement of 470 mL after the addition of treatment with MTX. The tolerance was cceptable for 7 patients. In one case, methotrexate was stopped due to poor tolerability with onset of bronchospasm and skin rash. In another case, the treatment was stopped because of repeated infections. In this limited group of patients, we found that MTX may be considered as an additional alternative treatment for severe asthma and allows OCS dose reduction. Moreover, MTX appeared to be efficient in atopic and non-atopic asthma.